PROJECT ABSTRACT
Approximately 1 million autistics will turn 18 in the next decade, many without the skills they need to achieve the
quality-of-life that they and their families’ desire. Without effective supports, autistic youth struggle with daily
living skills, regardless of their intellectual abilities. Daily living skills are fundamental to independence, paid
employment, and better quality-of-life for autistic adults. Existing daily living skill interventions for this age group
have only modest effects or show poor generalization to real world settings. Current treatments rely on explicit
instruction of specific daily living skills (e.g., the steps for taking a shower), and they lack inclusion of mutable
psychological factors that support the development and generalization of daily living skills. Treatments are further
limited by inadequate knowledge of how social determinants of health (e.g., family income, community
resources) contribute to daily living skills. Identification of mutable psychological factors and social determinants
of health driving change in daily living skills for transition-age autistic youth is a vital to improving public health
and social justice. This knowledge will identify pivotal intervention and service delivery targets for improving daily
living skills. Better executive function and self-determination skills are associated with more advanced daily living
skills, and both factors improve with treatment in autism. Our central scientific premise is that interventions for
daily living skills, and the service delivery systems that promote them, will be enhanced with greater knowledge
of psychological and systemic factors that directly impact these skills. Further, enhanced daily living skills will
result in downstream improvements in quality-of-life and productivity. This project will address gaps in our
knowledge with a prospective longitudinal study that evaluates psychological factors that drive change in daily
living skills during the time when autistic youth exit high school (AIM 1), as well as the impact of daily living skills
on quality-of-life (AIM 2). We will also explore the influence of both individual- (e.g., family income) and
neighborhood-level (childhood opportunity index) factors on daily living skills (AIM 3). Finally, there is a general
need for large representative samples (i.e., IQ range, speaking/nonspeaking, sex-assigned-at-birth, gender,
race, ethnicity). The proposed longitudinal study will contain 3 visits (T1: baseline, T2: +1 yr., T3: +2 yrs.; final
N=170). Our recruitment strategy will ensure all participants have at least one timepoint pre- and post-high school
exit. We predict: AIM 1, H1) executive function and self-determination will explain significant variance in
concurrent daily living skills above covariates; AIM 1, H2a,b) executive functioning and self-determination at
baseline will predict daily living skills at T3 and change in daily living skills over time above covariates; AIM 2,
H3a,b) larger increases in daily living skills will predict better objective and subjective quality-of-life and better
change in quality-of-life over time. In AIM 3, we explore both direct and indirect effects of social determinants of
health. This project will generate critical knowledge for enhancing daily living skills interventions and delivery
systems that will improve long-term outcomes for autistic adults and increase equitable access to services.
